Provider Demographics
NPI:1972780906
Name:CLEAR LAKE INTERNAL MEDICINE CARE PA
Entity Type:Organization
Organization Name:CLEAR LAKE INTERNAL MEDICINE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FIROOZEH
Authorized Official - Middle Name:ROSE SAHEB
Authorized Official - Last Name:KAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-770-0691
Mailing Address - Street 1:PO BOX 891125
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-1125
Mailing Address - Country:US
Mailing Address - Phone:713-770-0691
Mailing Address - Fax:
Practice Address - Street 1:709 MEDICAL CENTER DR.
Practice Address - Street 2:CORNERSTONE HOSPITAL
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:713-770-0691
Practice Address - Fax:281-220-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2581174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174317101Medicaid
TXDD2664OtherRAILROAD MEDICARE
TX0054MSOtherBCBSTX
TXDD2664OtherRAILROAD MEDICARE